Cardiovascular

Question 1

What accounts for the majority of cardio problems for children in developed countries?

Answer 1

Congenital heart disease

Question 2

Name 3 genetic disorders associated with CHD?

Answer 2

Downs
Turner’s
DiGeorge

Question 3

What are the CHD associations with Down’s, Turner’s and DiGeorge syndrome?

Answer 3

Downs - AV septal defect
Turners - Coarctation of the aorta
DiGeorge - Interrupted aortic arch

Question 4

Name 2 teratogens associated with CHD

Answer 4

alcohol

lithium

Question 5

What CHD defect is associated with alcohol?

Answer 5

AV septal defect

Question 6

What infection is associated with CHD and what defect can it lead to?

Answer 6

Rubella

patent ductus arteriosus

Question 7

What CHD defect is associated with maternal diabetes mellitus?

Answer 7

transposition of the great arteries

Question 8

6 symptoms of CHD in young children

Answer 8

poor feeding
cough
dyspnoea
sweating
faltering growth
recurrent chest infections

Question 9

5 symptoms of CHD in older children

Answer 9

syncope
palpitations 
SoB
exercise intolerence
Chest pain

Question 10

5 major physical signs of CHD

Answer 10

cyanosis
murmurs
cardiac failure
cardiogenic shock
finger clubbing (rare)

Question 11

What is central cyanosis and is it anything to worry about in children?

Answer 11

Blue lips and tongue

Always pathological

Question 12

What is peripheral cyanosis and is it anything to worry about in children?

Answer 12

Blue hands/feet.

Can be normal in newborns with first 24 hours

Question 13

How is central cyanosis due to CHD distinguished from that due to respiratory disease?

Answer 13

CHD - failure of the partial pressure of oxygen in the right radial artery to get above 15kPa after breathing 100% oxygen for 10 mins.

Question 14

Is a diastolic murmur in a child anything to worry about?

Answer 14

Always pathological

Question 15

5 features of likely innocent murmurs in children?

Answer 15

Asymptomatic child
normal CV examination
systolic or continuous
no radiation 
variation with posture

Question 16

What is the most common variety of CHD?

Answer 16

ventricular septal defect

Question 17

What is rheumatic fever and what is it caused by?

Answer 17

abnormal immune response to streptococcal infection

Question 18

What criteria is used for diagnosing rheumatic fever?

Answer 18

Jones criteria

Question 19

What is the required criteria for diagnnosing rheumatic fever?

Answer 19

Evidence of streptococcal infection

throat swab or raised antistrepolysin

Question 20

What are 5 major criteria for diagnosing rheumatic fever?

Answer 20

Polyarthritis (fleeting major joints)
Erythema marginatum
Subcutaneous nodules
Carditis 
Chorea

Question 21

What blood markers would be raised in someone with rheumatic fever?

Answer 21

ESR
CRP
While cell count

Question 22

4 minor criteria for diagnosing rheumatic fever?

Answer 22

Fever
Arthralgia
Previous rheumatic fever
Prolonged PR interval

Question 23

5 management steps for rheumatic fever

Answer 23

bed rest
aspirin
steriods
diuretics and ACEi for heart failure 
antibiotics

Question 24

When should infective endocarditis be suspected?

Answer 24

Any child with fever and significant cardiac murmur

Question 25

Clinical features of infective endocarditis associate with the following causes:
Bacteraemia
Valvulitis
immunological process
embolic

Answer 25

Fever, malaise
cardiac and murmurs
glomerulonephritis
CNS abcesses and splinter haemorrhages

Question 26

Lab diagnosis tools for suspected endocarditis?

Answer 26

Blood cultures x3 in first 24 hours of hospitalisation.

Cross sectional echo (cannot exclude only confirm)

Question 27

What is the most common causative organism of infective endocarditis?

Answer 27

Streptococcus viridans

Question 28

Mgmt of infective endocarditis

Answer 28

4-6 weeks of IV antibiotics

possible removal of infected implant